U.S. patent application number 14/795546 was filed with the patent office on 2016-02-11 for surgical instruments and methods for performing tonsillectomy and adenoidectomy procedures.
The applicant listed for this patent is COVIDIEN LP. Invention is credited to RYAN C. ARTALE, REBECCA J. COULSON, GARY M. COUTURE, JOHN R. TWOMEY, DAVID J. VAN TOL.
Application Number | 20160038224 14/795546 |
Document ID | / |
Family ID | 55266546 |
Filed Date | 2016-02-11 |
United States Patent
Application |
20160038224 |
Kind Code |
A1 |
COUTURE; GARY M. ; et
al. |
February 11, 2016 |
SURGICAL INSTRUMENTS AND METHODS FOR PERFORMING TONSILLECTOMY AND
ADENOIDECTOMY PROCEDURES
Abstract
An end effector assembly for a surgical instrument includes a
pair of jaw members each including one or more tissue-contacting
plates. One or both jaw members is movable relative to the other
between spaced-apart and approximated positions for grasping tissue
between the tissue-contacting plates. The tissue-contacting plates
are adapted to connect to a source of energy for conducting energy
through tissue grasped between. One of the jaw members includes an
insulative member extending towards the other member. The
insulative member includes a plurality of crests each defining a
blunt apex and a proximally-facing sharpened edge. The blunt apexes
contact tissue upon approximation of the first and second jaw
members to grasp tissue, while the proximally-facing sharpened
edges facilitate tissue cutting in a ripping fashion upon proximal
translation of the end effector assembly relative to tissue.
Inventors: |
COUTURE; GARY M.; (WARD,
CO) ; ARTALE; RYAN C.; (BOULDER, CO) ; TWOMEY;
JOHN R.; (SUPERIOR, CO) ; COULSON; REBECCA J.;
(LYONS, CO) ; VAN TOL; DAVID J.; (BOULDER,
CO) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
COVIDIEN LP |
MANSFIELD |
MA |
US |
|
|
Family ID: |
55266546 |
Appl. No.: |
14/795546 |
Filed: |
July 9, 2015 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
62035814 |
Aug 11, 2014 |
|
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|
62035799 |
Aug 11, 2014 |
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Current U.S.
Class: |
606/51 |
Current CPC
Class: |
A61B 17/295 20130101;
A61B 17/26 20130101; A61B 2017/32007 20170801; A61B 2018/1452
20130101; A61B 17/320068 20130101; A61B 2017/2926 20130101; A61B
2018/1457 20130101; A61B 2017/320069 20170801; A61B 2018/00327
20130101; A61B 18/1445 20130101 |
International
Class: |
A61B 18/14 20060101
A61B018/14 |
Claims
1. An end effector assembly for a surgical instrument, comprising:
first and second jaw members, each of the first and second jaw
members including at least one tissue-contacting plate disposed
thereon, at least one of the first and second jaw members movable
relative to the other between a spaced-apart position and an
approximated position for grasping tissue between the
tissue-contacting plates, the tissue-contacting plates of the first
and second jaw members adapted to connect to a source of energy for
conducting energy through tissue grasped therebetween, the first
jaw member including: an insulative member extending from the first
jaw member towards the second jaw member, the insulative member
including a plurality of crests, each crest defining a blunt apex
and a proximally-facing sharpened edge, the blunt apexes configured
to contact tissue upon approximation of the first and second jaw
members to grasp tissue, the proximally-facing sharpened edges
configured to facilitate tissue cutting in a ripping fashion upon
proximal translation of the end effector assembly relative to
tissue.
2. The end effector assembly according to claim 1, wherein the
first jaw member includes a pair of spaced-apart tissue-contacting
plates, and wherein the insulative member is disposed between the
spaced-apart tissue-contacting plates of the first jaw member.
3. The end effector assembly according to claim 2, wherein the
tissue-contacting plate of the second jaw member is positioned to
oppose the spaced-apart tissue-contacting plates of the first jaw
member and the insulative member of the first jaw member.
4. The end effector assembly according to claim 3, wherein energy
is configured to be conducted between the tissue-contacting plate
of the second jaw member and each of the spaced-apart
tissue-contacting plates of the first jaw member to define a pair
of tissue treatment areas on either side of the insulative
member.
5. The end effector assembly according to claim 3, wherein the
insulative member is configured to define a minimum gap distance
between the tissue-contacting plates of the first jaw member and
the tissue-contacting plate of the second jaw member in the
approximated position of the first and second jaw members.
6. The end effector assembly according to claim 1, wherein the
plurality of crests are spaced-apart from one another to define a
lull between each pair of adjacent crests.
7. An end effector assembly for a surgical instrument, comprising:
first and second jaw members, each of the first and second jaw
members including a tissue-contacting plate disposed thereon, at
least one of the first and second jaw members movable relative to
the other between a spaced-apart position and an approximated
position for grasping tissue between the tissue-contacting plates,
the tissue-contacting plates defining a tissue-treatment area
therebetween and adapted to connect to a source of energy for
conducting energy through tissue grasped within the
tissue-treatment area, the first jaw member including: an
insulative member extending from the first jaw member towards the
second jaw member, the insulative member positioned on an outer
peripheral edge of the first jaw member exteriorly of the
tissue-treatment area and configured to facilitate cutting of
tissue positioned adjacent the tissue-treatment area upon at least
one of movement of the first and second jaw members to the
approximated position or manipulation of the end effector assembly
relative to tissue.
8. The end effector assembly according to claim 7, wherein the
insulative member includes a first finger extending from an outer
side edge of the first jaw member towards the second jaw member and
positioned exteriorly of the tissue-treatment area, the first
finger positioned in close proximity to or abutment with the second
jaw member when the first and second jaw members are disposed in
the approximated position such that tissue disposed between the
first finger and the second jaw member is shear-cut upon movement
of the first and second jaw members to the approximated
position.
9. The end effector assembly according to claim 8, wherein a
portion of the first jaw member overhangs the second jaw member,
and wherein the first finger extends from the first portion of the
first jaw member.
10. The end effector assembly according to claim 8, wherein the
second jaw member includes a second finger positioned on an outer
peripheral edge of the second jaw member exteriorly of the
tissue-treatment area between the tissue-treatment area and the
first finger, the first and second fingers positioned in close
proximity to or abutment with one another when the first and second
jaw members are disposed in the approximated position such that
tissue disposed between the first and second fingers is shear-cut
upon movement of the first and second jaw members to the
approximated position.
11. The end effector assembly according to claim 7, wherein the
insulative member includes a tooth extending from an outer side
edge of the first jaw member towards the second jaw member and
positioned exteriorly of the tissue-treatment area, the tooth
defining a sharpened edge configured to facilitate tissue cutting
in a ripping fashion upon manipulation of the end effector assembly
relative to tissue.
12. The end effector assembly according to claim 11, wherein the
tooth is configured for at least partial receipt within a cut-out
defined within the second jaw member.
13. An end effector assembly for a surgical instrument, comprising:
first and second jaw members, each of the first and second jaw
members including a tissue-contacting plate disposed thereon, at
least one of the first and second jaw members movable relative to
the other between a spaced-apart position and an approximated
position for grasping tissue between the tissue-contacting plates,
the tissue-contacting plates of the first and second jaw members
adapted to connect to a source of energy for conducting energy
through tissue grasped therebetween, wherein the tissue contacting
plate of the second jaw member defines a symmetrical configuration
having a first side and a second side, wherein the
tissue-contacting plate of the first jaw member defines an
asymmetrical configuration having a first side and a second side,
the first and second sides of the tissue-contacting plate of first
jaw member positioned to oppose the first and second sides of the
tissue-contacting plate of the second jaw member and define a
tissue-treatment area therebetween, the first side of the
tissue-contacting plate of the first jaw member defining a minimum
height and the second side of the tissue-contacting plate of the
first jaw member defining a maximum height such that
tissue-contacting surfaces of the tissue-contacting plates of the
first and second jaw members are disposed in non-parallel
orientation relative to one another; and an insulative member
disposed on the tissue-contacting plate of the first jaw member at
the second side thereof and positioned to oppose the second side of
the tissue-contacting plate of the second jaw member, the
insulative member configured to facilitate cutting tissue along an
outer edge of the tissue-treatment area in a ripping fashion upon
manipulation of the end effector assembly relative to tissue.
14. The end effector assembly according to claim 13, wherein the
insulative member is an insulative cap or coating disposed on the
first jaw member at the second side thereof.
15. The end effector assembly according to claim 13, wherein the
insulative member defines a sharpened tip portion.
16. The end effector assembly according to claim 13, wherein the
insulative member is configured to define a minimum gap distance
between the tissue-contacting plates of the first and second jaw
members in the approximated position of the first and second jaw
members.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of, and priority to,
U.S. Provisional Patent Application Nos. 62/035,814 and 62/035,799,
both of which were filed on Aug. 11, 2014. This application is
related to U.S. patent application Ser. No. ______, filed on
______. The entire contents of each of the above applications are
hereby incorporated herein by reference.
BACKGROUND
[0002] 1. Technical Field
[0003] The present disclosure relates to surgical instruments and
methods and, more particularly, to surgical instruments and methods
for performing tonsillectomy and/or adenoidectomy procedures.
[0004] 2. Background of Related Art
[0005] The tonsils and adenoids are part of the lymphatic system
and are generally located in the back of the throat. These parts of
the lymphatic system are generally used for sampling bacteria and
viruses entering the body and activating the immune system when
warranted to produce antibodies to fight oncoming infections. More
particularly, the tonsils and adenoids break down the bacteria or
virus and send pieces of the bacteria or virus to the immune system
to produce antibodies for fighting off infections.
[0006] Inflammation of the tonsils and adenoids (e.g., tonsillitis)
impedes the ability of the tonsils and adenoids to destroy the
bacteria resulting in a bacterial infection. In many instances, the
bacteria remain even after treatment and serve as a reservoir for
repeated infections (e.g., tonsillitis or ear infections).
[0007] A tonsillectomy and/or adenoidectomy may be performed when
infections persist and antibiotic treatments fail. Persistent
infection typically leads to enlarged tonsil tissue which may need
to be removed since in many cases the enlarged tissue causes airway
obstruction leading to various sleep disorders such as snoring or,
in some cases, sleep apnea. Some individuals are also born with
larger tonsils that are more prone to cause obstruction. An
adenoidectomy may also be required to remove adenoid tissue when
ear pain persists, or when nose breathing or function of the
Eustachian tube is impaired. Often times, tonsillectomy and
adenoidectomy procedures are performed at the same time.
SUMMARY
[0008] As used herein, the term "distal" refers to the portion that
is being described which is further from a user, while the term
"proximal" refers to the portion that is being described which is
closer to a user. Further, to the extent consistent, any of the
aspects described herein may be used in conjunction with any or all
of the other aspects described herein.
[0009] In accordance with the present disclosure, an end effector
assembly for a surgical instrument is provided including first and
second jaw members each having one or more tissue-contacting plates
disposed thereon. One or both of the jaw members is movable
relative to the other between a spaced-apart position and an
approximated position for grasping tissue between the
tissue-contacting plates. The tissue-contacting plates are adapted
to connect to a source of energy for conducting energy through
tissue grasped therebetween. One of the jaw members, e.g., the
first jaw member, includes an insulative member extending from the
first jaw member towards the second jaw member. The insulative
member includes a plurality of crests each defining a blunt apex
and a proximally-facing sharpened edge. The blunt apexes are
configured to contact tissue upon approximation of the first and
second jaw members to grasp tissue. The proximally-facing sharpened
edges, on the other hand, are configured to facilitate tissue
cutting in a ripping fashion upon proximal translation of the end
effector assembly relative to tissue.
[0010] In an aspect of the present disclosure, the first jaw member
includes a pair of spaced-apart tissue-contacting plates and the
insulative member is disposed between the spaced-apart
tissue-contacting plates of the first jaw member.
[0011] In another aspect of the present disclosure, the
tissue-contacting plate of the second jaw member is positioned to
oppose the spaced-apart tissue-contacting plates of the first jaw
member and the insulative member of the first jaw member.
[0012] In yet another aspect of the present disclosure, energy is
configured to be conducted between the tissue-contacting plate of
the second jaw member and each of the spaced-apart
tissue-contacting plates of the first jaw member to define a pair
of tissue treatment areas on either side of the insulative
member.
[0013] In still another aspect of the present disclosure, the
insulative member is configured to define a minimum gap distance
between the tissue-contacting plates of the first jaw member and
the tissue-contacting plate of the second jaw member in the
approximated position of the first and second jaw members.
[0014] In still yet another aspect of the present disclosure, the
plurality of crests are spaced-apart from one another to define a
lull between each pair of adjacent crests.
[0015] In accordance with the present disclosure, another end
effector assembly for a surgical instrument is provided including
first and second jaw members each having a tissue-contacting plate
disposed thereon. One or both of the first and second jaw members
is movable relative to the other between a spaced-apart position
and an approximated position for grasping tissue between the
tissue-contacting plates. The tissue-contacting plates define a
tissue-treatment area therebetween and are adapted to connect to a
source of energy for conducting energy through tissue grasped
within the tissue-treatment area. One of the jaw members, e.g., the
first jaw member, includes an insulative member extending from the
first jaw member towards the second jaw member. The first jaw
member is positioned on an outer peripheral edge of the first jaw
member exteriorly of the tissue-treatment area and is configured to
facilitate cutting of tissue positioned adjacent the
tissue-treatment area upon movement of the jaw members to the
approximated position and/or manipulation of the end effector
assembly relative to tissue.
[0016] In an aspect of the present disclosure, the insulative
member includes a first finger extending from an outer side edge of
the first jaw member towards the second jaw member. The first
finger is positioned exteriorly of the tissue-treatment area in
close proximity to or abutment with the second jaw member when the
first and second jaw members are disposed in the approximated
position. As such, tissue disposed between the first finger and the
second jaw member is shear-cut upon movement of the first and
second jaw members to the approximated position.
[0017] In another aspect of the present disclosure, a portion of
the first jaw member overhangs the second jaw member. In such a
configuration, the first finger may be positioned to extend from
the first portion of the first jaw member.
[0018] In yet another aspect of the present disclosure, the second
jaw member includes a second finger positioned on an outer
peripheral edge of the second jaw member exteriorly of the
tissue-treatment area between the tissue-treatment area and the
first finger. The first and second fingers are positioned in close
proximity to or abutment with one another when the first and second
jaw members are disposed in the approximated position such that
tissue disposed between the first and second fingers is shear-cut
upon movement of the first and second jaw members to the
approximated position.
[0019] In still another aspect of the present disclosure, the
insulative member includes a tooth extending from an outer side
edge of the first jaw member towards the second jaw member. The
tooth is positioned exteriorly of the tissue-treatment area. The
tooth defines a sharpened edge configured to facilitate tissue
cutting in a ripping fashion upon manipulation of the end effector
assembly relative to tissue.
[0020] In still yet another aspect of the present disclosure, the
tooth is configured for at least partial receipt within a cut-out
defined within the second jaw member.
[0021] In accordance with the present disclosure, another end
effector assembly for a surgical instrument is provided. The end
effector assembly includes first and second jaw members each having
a tissue-contacting plate disposed thereon. One or both of the jaw
members is movable relative to the other between a spaced-apart
position and an approximated position for grasping tissue between
the tissue-contacting plates. The tissue-contacting plates are
adapted to connect to a source of energy for conducting energy
through tissue grasped therebetween. The tissue contacting plate of
one of the jaw members, e.g., the second jaw member, defines a
symmetrical configuration having a first side and a second side.
The tissue-contacting plate of the other jaw member, e.g., the
first jaw member, defines an asymmetrical configuration having a
first side and a second side. The first and second sides of the
tissue-contacting plate of the first jaw member are respectively
positioned to oppose the first and second sides of the
tissue-contacting plate of the second jaw member and define a
tissue-treatment area therebetween. The first side of the
tissue-contacting plate of the first jaw member defines a minimum
height and the second side of the tissue-contacting plate of the
first jaw member defines a maximum height such that
tissue-contacting surfaces of the tissue-contacting plates of the
first and second jaw members are disposed in non-parallel
orientation relative to one another. An insulative member is
disposed on the tissue-contacting plate of the first jaw member at
the second side thereof and is positioned to oppose the second side
of the tissue-contacting plate of the second jaw member. The
insulative member is configured to facilitate cutting tissue along
an outer edge of the tissue-treatment area in a ripping fashion
upon manipulation of the end effector assembly relative to
tissue.
[0022] In an aspect of the present disclosure, the insulative
member is an insulative cap disposed on the first jaw member at the
second side thereof. Alternatively, an insulative coating may be
disposed on the first jaw member at the second side thereof. Other
suitable insulative members are also contemplated.
[0023] In another aspect of the present disclosure, the insulative
member defines a sharpened tip portion.
[0024] In yet another aspect of the present disclosure, the
insulative member is configured to define a minimum gap distance
between the tissue-contacting plates of the first and second jaw
members in the approximated position of the first and second jaw
members.
[0025] Methods of treating and separating, e.g., cutting, tissue
are also provided in accordance with the present disclosure. Such
methods may find particular use in conjunction with any of the
above-detailed end effector assemblies.
BRIEF DESCRIPTION OF THE DRAWINGS
[0026] Various aspects and features of the present disclosure are
described herein with reference to the drawings wherein:
[0027] FIG. 1 is a front, side, perspective view of an endoscopic
surgical forceps configured for use in accordance with the present
disclosure;
[0028] FIG. 2 is a front, side, perspective view of an open
surgical forceps configured for use in accordance with the present
disclosure;
[0029] FIG. 3 is a side, cut-away view of the proximal portion of
the surgical forceps of FIG. 1, wherein a portion of the housing
and some of the internal components thereof have been removed to
unobstructively illustrate the handle and drive assemblies of the
forceps;
[0030] FIG. 4 is a perspective, cut-away view of the distal portion
of the surgical forceps of FIG. 1, wherein the shaft has been
removed to illustrate the drive bar and end effector assembly of
the forceps;
[0031] FIG. 5A is a longitudinal, cross-sectional side view of the
distal portion of an end effector assembly provided in accordance
with the present disclosure and configured for use with the
surgical forceps of FIGS. 1 and 2, or any other suitable surgical
instrument;
[0032] FIG. 5B is a transverse, cross-sectional view of the end
effector assembly of FIG. 5A taken along section line "5B-5B" of
FIG. 5A;
[0033] FIG. 6 is a transverse, cross-sectional view of another end
effector assembly provided in accordance with the present
disclosure and configured for use with the surgical forceps of
FIGS. 1 and 2, or any other suitable surgical instrument;
[0034] FIG. 7 is a transverse, cross-sectional view of still
another end effector assembly provided in accordance with the
present disclosure and configured for use with the surgical forceps
of FIGS. 1 and 2, or any other suitable surgical instrument;
[0035] FIG. 8 is a transverse, cross-sectional view of yet another
end effector assembly provided in accordance with the present
disclosure and configured for use with the surgical forceps of
FIGS. 1 and 2, or any other suitable surgical instrument;
[0036] FIG. 9 is a transverse, cross-sectional view of still yet
another end effector assembly provided in accordance with the
present disclosure and configured for use with the surgical forceps
of FIGS. 1 and 2, or any other suitable surgical instrument;
[0037] FIG. 10 is a transverse, cross-sectional view of another end
effector assembly provided in accordance with the present
disclosure and configured for use with the surgical forceps of
FIGS. 1 and 2, or any other suitable surgical instrument; and
[0038] FIG. 11 is a transverse, cross-sectional view of still
another end effector assembly provided in accordance with the
present disclosure and configured for use with the surgical forceps
of FIGS. 1 and 2, or any other suitable surgical instrument.
DETAILED DESCRIPTION
[0039] Turning to FIGS. 1 and 2, FIG. 1 depicts a handheld,
shaft-based surgical forceps 10 and FIG. 2 depicts a hemostat-style
forceps 10'. For the purposes herein, either forceps 10, forceps
10', or any other suitable surgical instrument may be utilized in
accordance with the present disclosure. Obviously, different
electrical and mechanical connections and considerations apply to
each particular type of instrument; however, the aspects and
features of the present disclosure remain generally consistent
regardless of the particular instrument used.
[0040] Referring to FIG. 1, forceps 10 generally includes a housing
20, a handle assembly 30, a rotating assembly 70, an activation
switch 4, and an end effector assembly 100. Forceps 10 further
includes a shaft 12 having a distal end 14 configured to
mechanically engage end effector assembly 100 and a proximal end 16
that mechanically engages housing 20. Forceps 10 also includes
cable 2 that connects forceps 10 to an energy source (not shown),
e.g., a generator or other suitable power source, although forceps
10 may alternatively be configured as a battery-powered device.
Cable 2 includes a wire (or wires) (not shown) extending
therethrough that has sufficient length to extend through shaft 12
in order to provide energy to one or both tissue-contacting plates
114, 124 (FIG. 4) of jaw members 110, 120, respectively. Activation
switch 4 is coupled to tissue-contacting plates 114, 124 (FIG. 4)
of jaw members 110, 120, respectively, and the source of energy for
selectively activating the supply of energy to jaw members 110, 120
for treating, e.g., cauterizing, coagulating/desiccating, and/or
sealing, tissue.
[0041] With additional reference to FIGS. 3 and 4, handle assembly
30 includes fixed handle 50 and a movable handle 40. Fixed handle
50 is integrally associated with housing 20 and handle 40 is
movable relative to fixed handle 50. Movable handle 40 of handle
assembly 30 is operably coupled to a drive assembly 140 that,
together, mechanically cooperate to impart movement of one or both
of jaw members 110, 120 about a pivot 103 between a spaced-apart
position and an approximated position to grasp tissue between jaw
members 110, 120. In particular, movable handle 40 is coupled to
drive bar 142 via a drive mandrel 144 such that movement of movable
handle 40 relative to housing 20 effects longitudinal translation
of drive bar 142 through housing 20 and shaft 12. The distal end of
drive bar 142 is coupled to one or both jaw members 110, 120 such
that longitudinal translation of drive bar 142 relative to end
effector assembly 100 pivots one or both of jaw members 110, 120
relative to one another. As shown in FIG. 1, movable handle 40 is
initially spaced-apart from fixed handle 50 and, correspondingly,
jaw members 110, 120 are disposed in the spaced-apart position.
Movable handle 40 is depressible from this initial position to a
depressed position corresponding to the approximated position of
jaw members 110, 120. Further, a biasing member 146 may be disposed
within housing 20 and positioned to bias drive bar 142 distally,
thereby biasing jaw members 110, 120 towards the spaced-apart
position. However, other configurations are also contemplated.
[0042] Referring to FIG. 2, forceps 10' is shown including two
elongated shaft members 12a, 12b, each having a proximal end 16a,
16b, and a distal end 14a, 14b, respectively. Forceps 10' is
configured for use with an end effector assembly 100' similar to
end effector assembly 100 (FIGS. 1 and 4). More specifically, end
effector assembly 100' includes first and second jaw members 110',
120' attached to respective distal ends 14a, 14b of shaft members
12a, 12b. Jaw members 110', 120' are pivotably connected about a
pivot 103'. Each shaft member 12a, 12b includes a handle 17a, 17b
disposed at the proximal end 16a, 16b thereof. Each handle 17a, 17b
defines a finger hole 18a, 18b therethrough for receiving a finger
of the user. As can be appreciated, finger holes 18a, 18b
facilitate movement of the shaft members 12a, 12b relative to one
another to, in turn, pivot jaw members 110', 120' from the
spaced-apart position, wherein jaw members 110', 120' are disposed
in spaced relation relative to one another, to the approximated
position, wherein jaw members 110', 120' cooperate to grasp tissue
therebetween.
[0043] One of the shaft members 12a, 12b of forceps 10', e.g.,
shaft member 12a, includes a proximal shaft connector 19 configured
to connect the forceps 10' to a source of energy (not shown), e.g.,
a generator. Proximal shaft connector 19 secures a cable 2' to
forceps 10' such that the user may selectively supply energy to jaw
members 110', 120' for treating tissue and for energy-based tissue
cutting. More specifically, an activation switch 4' is provided for
supplying energy to jaw members 110', 120' to treat tissue upon
sufficient approximation of shaft members 12a, 12b, e.g., upon
activation of activation switch 4' via shaft member 12b.
[0044] With reference to FIG. 4, end effector assembly 100 of
forceps 10 (FIG. 1) is shown, although end effector assembly 100
may similarly be used in conjunction with forceps 10' (FIG. 2), or
any other suitable surgical instrument. For purposes of simplicity,
end effector assembly 100 is described herein as configured for use
with forceps 10 (FIG. 1). Further, end effector assembly 100 is
generally described below with reference to FIG. 4, followed by a
detailed description, in conjunction with FIGS. 5A-11, of various
configurations of end effector assemblies suitable for use in
performing tonsillectomy and/or adenoidectomy procedures. Each of
these configurations may incorporate the general features of end
effector assembly 100 and may likewise be used with forceps 10
(FIG. 1), forceps 10' (FIG. 2), or any other suitable surgical
instrument. The general features detailed with respect to end
effector assembly 100 (FIG. 4), although applicable to the end
effector assemblies of FIGS. 5A-11, will not be repeated for
purposes of brevity.
[0045] Each jaw member 110, 120 of end effector assembly 100
includes a jaw frame having a proximal flange portion 111, 121, an
outer insulative jaw housing 112, 122 disposed about the distal
portion (not explicitly shown) of each jaw frame, and a
tissue-contacting plate 114, 124, respectively. Proximal flange
portions 111, 121 are pivotably coupled to one another about pivot
103 for moving jaw members 110, 120 between the spaced-apart and
approximated positions, although other suitable mechanisms for
pivoting jaw members 110, 120 relative to one another are also
contemplated. The distal portions (not explicitly shown) of the jaw
frames are configured to support jaw housings 112, 122, and
tissue-contacting plates 114, 124, respectively, thereon.
[0046] Outer insulative jaw housings 112, 122 of jaw members 110,
120 support and retain tissue-contacting plates 114, 124 on
respective jaw members 110, 120 in opposed relation relative to one
another. Tissue-contacting plates 114, 124 are formed from an
electrically conductive material, e.g., for conducting
electrosurgical energy therebetween for treating tissue, although
tissue-contacting plates 114, 124 may alternatively be configured
to conduct any suitable energy, e.g., thermal, microwave, light,
ultrasonic, etc., through tissue grasped therebetween for
energy-based tissue treatment. As mentioned above,
tissue-contacting plates 114, 124 are coupled to activation switch
4 (FIG. 1) and the source of energy (not shown), e.g., via the
wires (not shown) extending from cable 2 (FIG. 1) through forceps
10 (FIG. 1), such that energy may be selectively supplied to
tissue-contacting plate 114 and/or tissue-contacting plate 124 and
conducted therebetween and through tissue disposed between jaw
members 110, 120 to treat tissue.
[0047] Various different configurations of end effector assemblies,
similar to end effector assembly 100 (FIG. 4) are detailed below
with respect to FIGS. 5A-11. Each of these end effector assemblies
is configured to facilitate performing tonsillectomy and/or
adenoidectomy procedures, although such end effector assemblies may
similarly be beneficial for use in a variety of other procedures.
To the extent consistent, any of the features of any of these end
effector assemblies may be used in conjunction with any or all of
the other end effector assemblies described herein.
[0048] Turning to FIGS. 5A-5B, end effector assembly 200 includes
first and second jaw members 210, 220, respectively. One of the jaw
members, e.g., jaw member 220 includes an insulative jaw housing
222 having a substantially planar tissue-contacting plate 224
disposed on the opposing surface thereof. Plate 224 is adapted to
connect to a source of energy. The other jaw member, e.g., jaw
member 210, includes an insulative jaw housing 212 and a pair of
spaced-apart, substantially planar tissue-contacting plates 214a,
214b disposed on the opposing surface thereof. Plates 214a, 214b
are likewise adapted to connect to the source of energy. End
effector assembly 200 may define a bipolar configuration, wherein
plates 214a, 214b are charged to a first electrical potential and
plate 224 is charged to a second, different electrical potential
such that an electrical potential gradient is created for
conducting energy between plates 214a, 214b and plate 224 and
through tissue grasped therebetween for treating tissue.
[0049] Positioned between the spaced-apart plates 214a, 214b of jaw
member 210 is an insulative member 218. More specifically,
insulative member 218 extends longitudinally between plates 214a,
214b and towards jaw member 220. Insulative member 218 defines a
configuration having a plurality of crests 219a spaced-apart via a
plurality of lulls 219b. Each crest 219a defines a blunt apex 219c
and a proximally-extending sharpened edge 219d. As a result of this
configuration, blunt apexes 219c, not sharpened edges 219d, contact
tissue upon movement of jaw members 210, 220 to the approximated
position to grasp tissue therebetween. Thus, tissue is not cut
during grasping and supplying energy thereto. Insulative member 218
may also function as a stop member to set a minimum gap distance
between jaw members 210, 220 in the approximated position.
Accordingly, insulative member 218 may be configured to define a
height of between about 0.001 inches and about 0.010 inches to
achieve a similar minimum gap distance between jaw members 210,
220.
[0050] In use, end effector assembly 200, with jaw members 210, 220
disposed in the spaced-apart position, is manipulated into position
such that tissue to be treated and cut is disposed between jaw
members 210, 220. With respect to tonsillectomy procedures, for
example, end effector assembly 200 is positioned between the cavity
wall tissue (or other tissue to remain) and the tonsil tissue (or
other tissue to be removed). Once the desired position has been
achieved, jaw members 210, 220 are moved to the approximated
position to grasp tissue therebetween. Thereafter, plates 214a,
214b and plate 224 may be energized to different electrical
potentials for conducting energy between plates 214a, 214b and
plate 224 and through tissue grasped therebetween to treat the
grasped tissue.
[0051] Once tissue has been treated, the tissue to be removed,
e.g., the tonsil tissue, is separated from the tissue to remain,
e.g., the wall tissue. In order to separate the tissue, while
maintaining jaw members 210, 220 in the approximated position
grasping the previously treated tissue therebetween, end effector
assembly 200 is moved proximally relative to tissue. As end
effector assembly 200 is moved proximally, sharpened edges 219d of
insulative member 218 cut through tissue disposed between the two
tissue treatment areas, e.g., the area between plate 214a and the
opposed portion of plate 224 and the area between plate 214b and
the opposed portion of plate 224, in a "ripping" fashion, thereby
separating the tonsil tissue to be removed (on one side of the end
effector assembly 200) from the wall tissue to remain (on the other
side of end effector assembly 200). The separated tonsil tissue may
then be removed using end effector assembly 200, another grasping
instrument, a suction device, or via other suitable method.
[0052] Turning to FIG. 6, end effector assembly 300 includes first
and second jaw members 310, 320, respectively. Each jaw member 310,
320 includes a respective insulative jaw housing 312, 322 and a
pair of spaced-apart, substantially planar tissue-contacting plates
314a, 314b and 324a, 324b, respectively. Plates 314a, 314b are
positioned to oppose plates 324a, 324b and to grasp tissue
therebetween upon movement of jaw members 310, 320 to the
approximated position. Plates 314a, 314b and 324a, 324b are adapted
to connect to a source of energy. More specifically, end effector
assembly 300 may define a bipolar configuration, wherein plates
314a, 314b are charged to a first electrical potential and plates
324a, 324b are charged to a second, different electrical potential
such that an electrical potential gradient is created for
conducting energy between plates 314a, 314b and plates 324a, 324b
and through tissue grasped therebetween for treating tissue.
[0053] Positioned between the spaced-apart plates 314a, 314b and
324a, 324b of each jaw member 310, 320, respectively, is an
insulative member 318, 328, although in some embodiments only one
jaw member 310, 320 includes the insulative member 318, 328.
Insulative members 318, 328 extend from jaw members 310, 320
longitudinally between plates 314a, 314b and 324a, 324b,
respectively, and towards the other jaw member 320, 310,
respectively. Insulative members 318, 328 define generally
triangular transverse, cross-sectional configurations with apexes
319, 329, respectively, thereof oriented in opposed relation
relative to one another such that apexes 319, 329 meet one another
upon full approximation of jaw members 310, 320. Apexes 319, 329
may be sharpened or blunt. Insulative members 318, 328 may further
function as stop members to set the minimum gap distance between
jaw members 310, 320 in the approximated position. Accordingly,
insulative members 318, 328 may cooperate to define a total height,
e.g., the sum of the respective heights, of between about 0.001
inches and about 0.010 inches to achieve a similar minimum gap
distance between jaw members 310, 320 in the approximated
position.
[0054] In use, end effector assembly 300, with jaw members 310, 320
disposed in the spaced-apart position, is manipulated into position
such that tissue to be treated and cut is disposed between jaw
members 310, 320. With respect to tonsillectomy procedures, for
example, end effector assembly 300 is positioned between the wall
tissue to remain and the tonsil tissue to be removed. Once the
desired position has been achieved, jaw members 310, 320 are moved
to the approximated position to grasp tissue therebetween.
Thereafter, plates 314a, 314b and plates 324a, 324b may be
energized to different electrical potentials for conducting energy
therebetween and through the grasped tissue to treat the grasped
tissue.
[0055] Once tissue has been treated, the tonsil tissue is separated
from the wall tissue and removed. In order to separate the tonsil
tissue, while maintaining jaw members 310, 320 in the approximated
position grasping the previously treated tissue therebetween, end
effector assembly 300 is manipulated, e.g., translated
longitudinally, translated laterally, and/or rotated relative to
tissue. As end effector assembly 300 is moved relative to tissue,
tissue pinched between apexes 319, 329 is cut or separated via the
sharpened apexes 319, 329, in embodiments where so provided, and/or
the relatively high pressure concentration on tissue disposed
therebetween in a "ripping" fashion. More specifically, the tissue
is separated between the two treatment areas, e.g., between plates
314a, 324a on one side of insulative members 318, 328 and between
plates 314b, 324b on the other side of insulative members 318, 328,
thereby separating the tonsil tissue on one side of end effector
assembly 300 and the wall tissue on the other side of end effector
assembly 300. The separated tonsil tissue may then be removed
similarly as detailed above.
[0056] Turning to FIG. 7, end effector assembly 400 includes first
and second jaw members 410, 420, respectively. Each jaw member 410,
420 includes a respective insulative jaw housing 412, 422 and a
pair of spaced-apart, substantially planar tissue-contacting plates
414a, 414b and 424a, 424b, respectively. Plates 414a, 414b are
positioned to oppose plates 424a, 424b and to grasp tissue
therebetween upon movement of jaw members 410, 420 to the
approximated position. Plates 414a, 414b and 424a, 424b are adapted
to connect to a source of energy. More specifically, end effector
assembly 400 may define a bipolar configuration, wherein plates
414a, 414b are charged to a first electrical potential and plates
424a, 424b are charged to a second, different electrical potential
such that an electrical potential gradient is created for
conducting energy between plates 414a, 414b and plates 424a, 424b
and through tissue grasped therebetween for treating tissue.
[0057] One of the jaw members, e.g., jaw member 410, includes an
insulative member 418 extending longitudinally between spaced-apart
plates 414a, 414b. Insulative member 418 extends from jaw member
410 towards jaw member 420 and defines a generally rectangular
transverse, cross-sectional configuration. As a result of this
configuration, insulative member 418 includes a pair of corner
edges 419a, 419b which may be sharpened to facilitate cutting
tissue. Alternatively, corners 419a, 419b may be angled or curved
to define blunt configurations.
[0058] The other jaw member, e.g., jaw member 420, includes a
recess 428 defined within jaw housing 422 thereof and positioned
between spaced-apart plates 424a, 424b. Recess 428 extends
longitudinally along jaw member 420 and defines a generally
rectangular transverse, cross-sectional configuration that is
complementary to the configuration of insulative member 418. More
specifically, recess 428 may be similarly sized or slightly larger
than insulative member 418 so as to at least partially receive
insulative member 418 therein upon approximation of jaw members
410, 420. As a result of this configuration, corner edges 419a,
419b abut or are disposed in close proximity to interior walls 429
defining recess 428 when jaw members 410, 420 are moved to the
approximated position.
[0059] Insulative member 418 and recess 428 may cooperate to
function as a stop member to set a minimum gap distance between jaw
members 410, 420 in the approximated position. More specifically,
the difference between the height of insulative member 418 and the
depth of recess 428 may be selected so as to define a minimum gap
distance between jaw members 410, 420 within the ranges detailed
above (or other suitable range), when insulative member 418 bottoms
out within or is no longer capable of being advanced into recess
428.
[0060] In use, end effector assembly 400, with jaw members 410, 420
disposed in the spaced-apart position, is manipulated into position
such that tissue to be treated and cut is disposed between jaw
members 410, 420. With respect to tonsillectomy procedures, for
example, end effector assembly 400 is positioned between the wall
tissue to remain and the tonsil tissue to be removed. Once the
desired position has been achieved, jaw members 410, 420 are moved
to the approximated position to grasp tissue therebetween. At least
some tissue cutting or perforation due to shearing of insulative
member 418 relative to interior walls 429 of recess 428 may be
effected as jaw members 410, 420 are moved to the approximated
position. With tissue grasped between plates 414a, 414b and plates
424a, 424b, plates 414a, 414b and plates 424a, 424b may be
energized to different electrical potentials for conducting energy
therebetween and through the grasped tissue to treat the grasped
tissue.
[0061] Once tissue has been treated, the tonsil tissue is separated
from the wall tissue and removed. In order to separate the tonsil
tissue, if not sufficiently separated already, while maintaining
jaw members 410, 420 in the approximated position grasping the
previously treated tissue therebetween, end effector assembly 400
is manipulated, e.g., translated longitudinally, translated
laterally, and/or rotated relative to tissue. As end effector
assembly 400 is moved relative to tissue, the partially cut or
perforated tissue is pinched between corner edges 419a, 419b of
insulative member 418 and interior walls 429 defining recess 428 to
further cut and, ultimately separate the tonsil tissue to be
removed from the wall tissue to remain in a shearing fashion. The
cut-line, similarly as above, is defined between the two treatment
areas, e.g., between plates 414a, 424a on one side of insulative
member 418 and recess 428 and between plates 414b, 424b on the
other side of insulative member 418 and recess 428. The separated
tonsil tissue may then be removed similarly as detailed above.
[0062] With reference to FIG. 8, end effector assembly 500 includes
first and second jaw members 510, 520, respectively. Each jaw
member 510, 520 includes an insulative jaw housing 512, 522 having
a substantially planar tissue-contacting plate 514, 524 disposed on
the opposing surface thereof. Plates 514, 524 are adapted to
connect to a source of energy. More specifically, end effector
assembly 500 may define a bipolar configuration, wherein plate 514
is charged to a first electrical potential and plate 524 is charged
to a second, different electrical potential such that an electrical
potential gradient is created for conducting energy between plates
514, 524 and through tissue grasped therebetween for treating
tissue.
[0063] One of the jaw members, e.g., jaw member 510, defines an
increased width as compared to the other jaw member, e.g., jaw
member 520, such that a portion of jaw housing 512 overhangs jaw
member 520, e.g., is disposed outside the peripheral bounds of jaw
member 520. Extending from the overhanging portion of jaw member
510 is an insulative finger 518. Finger 518 extends longitudinally
along the outer side edge of jaw housing 512 and extends from jaw
housing 512 generally towards jaw member 520. However, due to the
fact that jaw housing 512 overhangs jaw member 520, finger 518
extends alongside at least a portion of jaw housing 522 of jaw
member 520, outside the tissue grasping area defined between plates
514, 524. Further, finger 518 extends in contact with or close
proximity with the corresponding outer peripheral edge 528 of jaw
housing 522 of jaw member 520 such that shearing between finger 518
and outer peripheral edge 528 is achieved upon movement of jaw
members 510, 520 to the approximated position. Finger 518 may
define a sharpened edge to facilitate shear cutting of tissue, or
may define a blunt edge.
[0064] In use, end effector assembly 500, with jaw members 510, 520
disposed in the spaced-apart position, is manipulated into position
such that tissue to be treated and cut is disposed between jaw
members 510, 520. With respect to tonsillectomy procedures, for
example, end effector assembly 500 is positioned between the wall
tissue to remain and the tonsil tissue to be removed with finger
518 disposed adjacent the tonsil tissue to be removed, e.g.,
spaced-apart from the wall tissue to remain. Once the desired
position has been achieved, jaw members 510, 520 are moved to the
approximated position to grasp tissue therebetween. At least some
tissue cutting or perforation due to shearing of finger 518
relative to outer peripheral edge 528 may be effected as jaw
members 510, 520 are moved to the approximated position.
Thereafter, plates 514, 524 may be energized to different
electrical potentials for conducting energy therebetween and
through the grasped tissue to treat the grasped tissue.
[0065] Once tissue has been treated, the tonsil tissue is separated
from the wall tissue and removed. In order to separate the tonsil
tissue, if not sufficiently done so already, while maintaining jaw
members 510, 520 in the approximated position grasping the
previously treated tissue therebetween, end effector assembly 500
is manipulated, e.g., translated longitudinally, translated
laterally, and/or rotated relative to tissue. More specifically,
end effector assembly 500 is moved relative to tissue to further
cut and ultimately separate the tonsil tissue to be removed from
the wall tissue to remain via separating the tissue pinched between
finger 518 of jaw member 510 and outer peripheral edge 528 of jaw
member 520 in a shearing fashion. In this configuration, the
cut-line is disposed on the tissue-to-be-removed side of the tissue
treatment area, spaced-apart from the wall tissue to remain. The
separated tonsil tissue may ultimately be removed, similarly as
detailed above.
[0066] Turning to FIG. 9, end effector assembly 600 generally
includes first and second jaw members 610, 620, respectively, each
having an insulative jaw housing 612, 622 and a substantially
planar tissue-contacting plate 614, 624 disposed on the opposing
surface thereof. Plates 614, 624 are adapted to connect to a source
of energy and may define a bipolar configuration, similarly as
detailed above with respect to end effector assembly 500 (FIG.
8).
[0067] One of the jaw members, e.g., jaw member 620, defines an
increased width as compared to the other jaw member, e.g., jaw
member 610, such that a portion 623 of jaw housing 622 overhangs
jaw housing 612 of jaw member 610, e.g., is disposed outside the
peripheral bounds of jaw member 610. Extending from portion 623 of
jaw member 620 is an outer insulative finger 628, disposed outside
the tissue-grasping area defined between plates 614, 624. Outer
finger 628 extends longitudinally along the outer side edge of
portion 623 of jaw housing 622 and extends from jaw housing 622
generally towards jaw member 610.
[0068] Jaw member 610 includes an inner insulative finger 618
disposed outside the tissue-grasping area defined between plates
614, 624 and positioned on the same side as outer finger 628. Inner
finger 618 extends longitudinally along the outer side edge of jaw
housing 612 and extends from jaw housing 612 towards jaw member 620
opposite portion 623 of law member 620. Inner finger 618 defines a
reduced height as compared to outer finger 628 to permit full
approximation of jaw members 610, 620. Inner and outer fingers 618,
628 are disposed in close proximity or abutment with one another
such that, upon movement of jaw members 610, 620 to the
approximated position, shear-cutting of tissue disposed between
fingers 618, 628 is effected.
[0069] As an alternative to being fixedly engaged to jaw housings
610, 620, fingers 618, 628 may be movably coupled to jaw housing
610, 620 via a biasing member (not explicitly shown) to delay the
shearing effect of fingers 618, 628 relative to the approximation
of jaw members 610, 620. As such, grasping of tissue and, if also
desired, initiation of tissue treatment may be effected prior to
fingers 618, 628 cutting tissue disposed therebetween. Finger 518
of end effector assembly 500 (see FIG. 8) may also be configured in
this manner.
[0070] In use, end effector assembly 600, with jaw members 610, 620
disposed in the spaced-apart position, is manipulated into position
such that tissue to be treated and cut is disposed between jaw
members 610, 620. With respect to tonsillectomy procedures, for
example, end effector assembly 600 is positioned between the wall
tissue to remain and the tonsil tissue to be removed such that
fingers 618, 628 are positioned adjacent the tonsil tissue to be
removed. Once the desired position has been achieved, jaw members
610, 620 are moved to the approximated position to grasp tissue
therebetween. Moving jaw members 610, 620 to the approximated
position effects shear-cutting (or at least partial shear-cutting)
of tissue disposed between fingers 618, 628 to at least partially
separate the tonsil tissue to be removed from the wall tissue.
Thereafter, or overlapping therewith, plates 614, 624 may be
energized to different electrical potentials for conducting energy
therebetween and through the grasped tissue to treat the grasped
wall tissue. The tonsil tissue may be further and fully separated
via shearing, if needed, by manipulating end effector assembly 600,
and ultimately removed, similarly as above.
[0071] Referring to FIG. 10, end effector assembly 700 includes
first and second jaw members 710, 720, respectively. Each jaw
member 710, 720 includes an insulative jaw housing 712, 722 having
a substantially planar tissue-contacting plate 714, 724 disposed on
the opposing surface thereof. Plates 714, 724 are adapted to
connect to a source of energy and may define a bipolar
configuration, similarly as detailed above.
[0072] One of the jaw members, e.g., jaw member 710, includes a
longitudinally-extending cut-out 718 defined along one of the outer
side edge portions 713 of jaw housing 712 such that one side of jaw
housing 712 defines a rounded outer side edge portion 713. The
other jaw member, e.g., jaw member 720 defines a tooth 728
extending longitudinally along the outer side edge of jaw housing
722 opposite cut-out 718. Tooth 728 extends from jaw housing 722
generally towards jaw member 710 and defines a sharpened edge 729.
Cut-out 718 at least partially accommodates tooth 728 to permit
full approximation of jaw members 710, 720. Further, both cut-out
718 and tooth 728 are disposed outside the tissue-grasping area
defined between plates 714, 724.
[0073] In use, end effector assembly 700, with jaw members 710, 720
disposed in the spaced-apart position, is manipulated into position
such that tissue to be treated and cut is disposed between jaw
members 710, 720. With respect to tonsillectomy procedures, for
example, end effector assembly 700 is positioned between the wall
tissue to remain and the tonsil tissue to be removed with tooth 728
positioned adjacent the tonsil tissue to be removed. Once the
desired position has been achieved, jaw members 710, 720 are moved
to the approximated position to grasp tissue therebetween. Some
tissue cutting or perforation via sharpened edge 729 of tooth 728
may be effected as jaw members 710, 720 are moved to the
approximated position. Thereafter, plates 714, 724 may be energized
to different electrical potentials for conducting energy
therebetween and through the grasped tissue to treat the grasped
tissue.
[0074] Once tissue has been treated, the tonsil tissue is separated
from the wall tissue and removed. In order to separate the tonsil
tissue, while maintaining jaw members 710, 720 in the approximated
position grasping the previously treated tissue therebetween, end
effector assembly 700 is manipulated, e.g., translated
longitudinally, translated laterally, and/or rotated relative to
tissue to cut (or further cut) and ultimately separate the tonsil
tissue from the wall tissue in a ripping fashion using sharpened
edge 729 of tooth 728. In this configuration, the cut-line,
similarly as with end effector assemblies 500, 600 (FIGS. 8 and 9,
respectively) is disposed on the tissue-to-be-removed side, e.g.,
the tonsil tissue side, of the tissue treatment area. The separated
tonsil tissue may ultimately be removed, similarly as detailed
above.
[0075] FIG. 11 illustrates another embodiment of an end effector
assembly 800. End effector assembly 800 includes first and second
jaw members 810, 820, respectively, each including an insulative
jaw housing 812, 822 and a tissue-contacting plate 814, 824 that is
adapted to connect to a source of energy. Plates 814, 824 may
define a bipolar configuration, similarly as detailed above. The
plate of one of the jaw members, e.g., plate 824 of jaw member 820,
defines a substantially planar, symmetrical, rectangular transverse
cross-sectional configuration. The plate of the other jaw member,
e.g., plate 814 of jaw member 810, defines an asymmetrical,
triangular transverse cross-sectional configuration wherein plate
814 defines a minimum thickness adjacent a first side thereof and a
maximum thickness adjacent a second, opposite side thereof. As a
result of this configuration, the tissue-contacting surface of
plate 814 is disposed in non-parallel orientation relative to the
tissue-contacting surface of plate 824.
[0076] A tip portion 818 of plate 814, disposed adjacent the
second, maximum thickness side thereof, may include an insulative
coating or an insulative cap to maintain electrical isolation
between plates 814, 824 in the approximated position of jaw members
810, 820 while also setting the minimum gap distance between jaw
members 810, 820 (within the range detailed above). Tip portion 818
may be sharpened to facilitate tissue cutting, although blunt
configurations are also contemplated. Tip portion 818 is disposed
at the outer boundary of the tissue-grasping area defined between
plates 814, 824. As such, substantial tissue treatment is effected
only on one side of tip portion 818, e.g., between tip portion 818
and the first, opposite side of plate 814.
[0077] In use, end effector assembly 800, with jaw members 810, 820
disposed in the spaced-apart position, is manipulated into position
such that tissue to be treated and cut is disposed between jaw
members 810, 820. With respect to tonsillectomy procedures, for
example, end effector assembly 800 is positioned between the wall
tissue to remain and the tonsil tissue to be removed such that tip
portion 818 of plate 814 is disposed adjacent the tonsil tissue to
be removed. Once the desired position has been achieved, jaw
members 810, 820 are moved to the approximated position to grasp
tissue therebetween. Some cutting or perforation of tissue disposed
between tip portion 818 of plate 814 and plate 824 may be effected
as jaw members 810, 820 are moved to the approximated position.
Thereafter, plates 814, 824 may be energized to different
electrical potentials for conducting energy therebetween and
through the grasped tissue to treat the grasped tissue.
[0078] Once tissue has been treated, the tonsil tissue is separated
from the wall tissue and removed. In order to separate the tonsil
tissue, while maintaining jaw members 810, 820 in the approximated
position grasping the previously treated tissue therebetween, end
effector assembly 800 is manipulated, e.g., translated
longitudinally, translated laterally, and/or rotated relative to
tissue. As end effector assembly 800 is moved relative to tissue,
tissue pinched between tip portion 818 of plate 814 and plate 824
is further cut in a ripping fashion using tip portion 818 to
ultimately separate the tonsil tissue to be removed from the wall
tissue to remain. As with end effector assemblies 500-700 (FIGS.
8-10, respectively), the cut-line in this configuration is disposed
on the tissue-to-be-removed side, e.g., the tonsil tissue side, of
the tissue treatment area. The separated tonsil tissue may
ultimately be removed, similarly as detailed above.
[0079] The various embodiments disclosed herein may also be
configured to work with robotic surgical systems and what is
commonly referred to as "Telesurgery." Such systems employ various
robotic elements to assist the surgeon and allow remote operation
(or partial remote operation) of surgical instrumentation. Various
robotic arms, gears, cams, pulleys, electric and mechanical motors,
etc. may be employed for this purpose and may be designed with a
robotic surgical system to assist the surgeon during the course of
an operation or treatment. Such robotic systems may include
remotely steerable systems, automatically flexible surgical
systems, remotely flexible surgical systems, remotely articulating
surgical systems, wireless surgical systems, modular or selectively
configurable remotely operated surgical systems, etc.
[0080] The robotic surgical systems may be employed with one or
more consoles that are next to the operating theater or located in
a remote location. In this instance, one team of surgeons or nurses
may prep the patient for surgery and configure the robotic surgical
system with one or more of the instruments disclosed herein while
another surgeon (or group of surgeons) remotely control the
instruments via the robotic surgical system. As can be appreciated,
a highly skilled surgeon may perform multiple operations in
multiple locations without leaving his/her remote console which can
be both economically advantageous and a benefit to the patient or a
series of patients.
[0081] The robotic arms of the surgical system are typically
coupled to a pair of master handles by a controller. The handles
can be moved by the surgeon to produce a corresponding movement of
the working ends of any type of surgical instrument (e.g., end
effectors, graspers, knifes, scissors, etc.) which may complement
the use of one or more of the embodiments described herein. The
movement of the master handles may be scaled so that the working
ends have a corresponding movement that is different, smaller or
larger, than the movement performed by the operating hands of the
surgeon. The scale factor or gearing ratio may be adjustable so
that the operator can control the resolution of the working ends of
the surgical instrument(s).
[0082] The master handles may include various sensors to provide
feedback to the surgeon relating to various tissue parameters or
conditions, e.g., tissue resistance due to manipulation, cutting or
otherwise treating, pressure by the instrument onto the tissue,
tissue temperature, tissue impedance, etc. As can be appreciated,
such sensors provide the surgeon with enhanced tactile feedback
simulating actual operating conditions. The master handles may also
include a variety of different actuators for delicate tissue
manipulation or treatment further enhancing the surgeon's ability
to mimic actual operating conditions.
[0083] From the foregoing and with reference to the various figure
drawings, those skilled in the art will appreciate that certain
modifications can also be made to the present disclosure without
departing from the scope of the same. While several embodiments of
the disclosure have been shown in the drawings, it is not intended
that the disclosure be limited thereto, as it is intended that the
disclosure be as broad in scope as the art will allow and that the
specification be read likewise. Therefore, the above description
should not be construed as limiting, but merely as exemplifications
of particular embodiments. Those skilled in the art will envision
other modifications within the scope and spirit of the claims
appended hereto.
* * * * *